Urinary and anal incontinence after vacuum delivery
ABSTRACT To evaluate urinary and fecal incontinence symptoms, and occult anal sphincter defects in women after vacuum and spontaneous vaginal delivery.
In a case-control study, 50 primiparous women delivered by vacuum extraction were compared to 50 women delivered spontaneously. Urinary and anal incontinence symptoms, pelvic floor muscle strength and sphincter defects on endoanal ultrasound were evaluated 6-24 weeks postpartum.
New anal incontinence symptoms after childbirth were found in 30% of the vacuum group compared to 34% of the controls, new urinary incontinence symptoms in 28 and 42%, respectively (not significant). After excluding Grade III perineal tear, sonographic sphincter defects were found in 11 (27.5%) after vacuum delivery compared to 4 (10%) after spontaneous delivery (P<0.05, chi(2)-test).
Anal and urinary incontinence symptoms are frequent after vaginal delivery. Vacuum delivery causes more sonographic sphincter defects but appears to cause no more harm to pelvic floor function than spontaneous vaginal delivery.
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- "Author and year Total number of participants Population characteristics and response rate where stated Risk factor studied Definition of case Time elapsed since exposure Liebling et al. 19 (2004) 314 393 women with term, singleton, cephalic pregnancies who required operative delivery at full dilatation Instrumental delivery; caesarean section at full dilatation Not explicitly defined 1 year Peschers et al. 20 (2003) 100 "
ABSTRACT: To assess if mode of delivery is associated with increased symptoms of anal incontinence following childbirth. Systematic review of all relevant studies in English. Medline, Embase, Cochrane Library, bibliographies of retrieved primary articles and consultation with experts. Data were extracted on study characteristics, quality and results. Exposure to risk factors was compared between women with and without anal incontinence. Categorical data in 2 x 2 contingency tables were used to generate odds ratios. Eighteen studies met the inclusion criteria with 12,237 participants. Women having any type of vaginal delivery compared with a caesarean section have an increased risk of developing symptoms of solid, liquid or flatus anal incontinence. The risk varies with the mode of delivery ranging from a doubled risk with a forceps delivery (OR 2.01, 95% CI 1.47-2.74, P < 0.0001) to a third increased risk for a spontaneous vaginal delivery (OR 1.32, 95% CI 1.04-1.68, P = 0.02). Instrumental deliveries also resulted in more symptoms of anal incontinence when compared with spontaneous vaginal delivery (OR 1.47, 95% CI 1.22-1.78). This was statistically significant for forceps deliveries alone (OR 1.5, 95% CI 1.19-1.89, P = 0.0006) but not for ventouse deliveries (OR 1.31, 95% CI 0.97-1.77, P = 0.08). When symptoms of solid and liquid anal incontinence alone were assessed, these trends persisted but were no longer statistically significant. Symptoms of anal incontinence in the first year postpartum are associated with mode of delivery.BJOG An International Journal of Obstetrics & Gynaecology 03/2008; 115(4):421-34. DOI:10.1111/j.1471-0528.2007.01553.x · 3.86 Impact Factor
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ABSTRACT: Combined urinary and faecal (liquid or solid) incontinence (double incontinence) is the most severe and debilitating manifestation of pelvic floor dysfunction. The community prevalence is 9-19% (urinary) and 5-10% (faecal), increasing with age. Pathophysiological factors include childbirth-associated external anal sphincter injury and pudendal nerve damage, pelvic floor descent, menopause, collagen disorders and multiple sclerosis-like conditions. The presence of crossed reflexes between the bladder, urethra, anorectum and pelvic floor in animal studies may explain the comorbidity of urinary and faecal urgency. Surgical treatment is based on aetiology and combined optimum techniques such as colposuspension or suburethral sling with overlapping sphincteroplasty. Other methods for improving sphincteric control include sacral nerve neuromodulation, bulking agents and artificial sphincters.International Urogynecology Journal 08/2005; 16(4):321-8. DOI:10.1007/s00192-004-1283-0 · 2.16 Impact Factor
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ABSTRACT: Le comportement du sphincter anal pendant la grossesse ne diffère pas de son état non gravide La grossesse induit chez un grand nombre de femmes une constipation que ľon peut qualifier de «physiologique» par augmentation de la réabsorption de ľeau au niveau du côlon. Elle n’en modifie pas pour autant le comportement de ľappareil sphinctérien anal.